A strong, healthy looking young man walked into the ER complaining of a bad asthma attack. A friend of mine, Peter, who had recently qualified as a nurse was part of the team that cared for him. They did everything they could, but his asthma attack had progressed too far and fast and he had waited too long to seek help. Despite valiant efforts by the team, he died. Peter felt like he had hit a wall of grief and guilt.  It was a stark moment for him. That night he went home and sank into a warm bath, crying about what he had witnessed.

Just a young priest at the time I did not know what to say to Peter when he told me the story. I sat with him quietly as he talked about his experience and how it had made him feel. He wondered whether he could have done more. He felt guilty. He remembered the patient being about his own age, and looking strong when he walked in to the ER. He could not believe the fact that a few hours later he was dead.

I didn’t know what to say at the time so I just listened. Looking back, I hope Peter knew the following as he reflected on this young mans death. I offer these reflections to you also:

Do Your Best
You have been given skills and training that make you the practitioner you are, do your best with those gifts. That is all that can be asked of you. Your skill as a surgeon is what your patient needs, and you apply it with all of your energy. On occasion it is not going to be enough, but you do all you can.

Remember Your Team
You are part of a team and the whole works together to heal patients. In Peter’s case, no one person was responsible for the loss, and no one could have stopped it.

If we take personal responsibility for saving every life we encounter it will create an impossible burden for us to bear. Share the load of work with your team and share the load of emption when a patient dies with someone who will listen carefully, a priest, pastor, therapist or rabbi.

Remember, you are part of a team that extends beyond the walls of the hospital. There are chaplains and social workers, family and friends who all contribute to the healing of patients. Learn to recognize the gifts of each and see yourself as a part of a whole. It is in community that we care for the sick. It is also in community that we can receive healing ourselves when we encounter loss.

Let Your Role Carry Some of the ‘Weight’
You are a surgeon, so become fluent in understanding your ‘role’. Be aware of the capacity and limitations of your function and let it carry some of the weight of the difficult choices you must face.

The role you occupy has a standard of practice associated with it; you had to train to enter into it, and you know what you are meant to do when you occupy it.

When I walk into a traumatic pastoral situation I always remember that I am walking in as a priest. I am not just Matthew Woodward, a friendly, slightly dippy guy who wants people to feel good. I may have to hear things that are hard to hear, or say things that are difficult to say, so I need to remember my role and listen and speak as a priest.

You may think I am detaching somewhat and hiding behind my role, but it is not insensitive or dismissive to say that I am being a priest when a priest is what is needed. A surgeon is what is needed in the OR. If I didn’t acknowledge my role and let it carry some of the weight, I would be crushed by the responsibility. So, I contemplate what it means to be in my role every day when I put on my clerical collar.

Take a moment to do that; contemplate what it means to be a surgeon every time you start a shift, when you put on your scrubs, or when you step into the hospital. Be mindful of it and let your role carry some of the weight of what it is you have to do.

Recap
What is the alternative to these three suggestions? Well, you might think that you are personally responsible for every life you encounter, you may imagine that you are solely responsible for every healthcare choice that someone else makes, and you could imagine you have the capacity to bend the laws of nature and make impossible outcomes occur. But none of that is real…

In order to avoid crashing into a wall of grief and guilt I recommend you get to know who you are and embrace your limitations; know what your role is; know who your team are; and, always do best with your skill and training.

Having said all of this, difficult moments will still take place: not every patient survives. The most important thing I can recommend when that happens? Be gentle with yourself and try to find someone at the end of the day that will listen to you as you tell him or her how you feel.

The Rev. Matthew Woodward leads Transfiguration Episcopal Church in San Mateo, California. He is originally from the UK and is now practicing near San Francisco. Over the years he has tried to learn to listen more than speak when people are telling him how they feel.  http://www.transfig-sm.org

Being mindful of what you are doing right now and/or what you are focused on at the moment is perhaps that first step in making minor shifts and changes that can have a significant impact on reducing your level of stress.  And it all starts with pulling yourself into the present moment.   Here are some simple steps for relieving unnecessary stress:

• Take responsibility for your stress level. Regardless of the challenges you face at the hospital or in private practice, and in personal life, it all starts with you and how you are taking care of yourself.  Being aware of how you feel, and of your immediate environment gives you the edge you need and allows you to be effective in handling yourself and others.  This approach allows you to be your best, including with the work in front of you.  What is critical is being aware of your thoughts and what you are focusing on.   If you are stressed about the past, work to let it go and pull yourself into present; if you are thinking or worrying about the future, stop and pull yourself back to the tasks at hand.

A Simple technique: Close your eyes, take a deep breath and, put both hands on your heart and say “I am aware of what I am feeling right now.”  Repeat 3 times. Use your breath to bring you back to present time.

• Create support systems for yourself in the hospital or outside your work environment.  This can have a direct impact on how you are managing stress.  Cultivate colleagues and those you respect to discuss important issues and be collaborative in finding solutions to situations that need to resolved or changed.  When you are feeling positive and supported, your stress levels are reduced.  Be open to having a mentor or confidante who can honestly talk with you about issues and situations that come up.  Recognize that there are times when you may not have all the answers yourself and need the input of people you respect – this can be very valuable.

Simple technique:  Intentionally create support in your professional life and work environment and/or recognize all the support that already exists.

• Create a peaceful home environment that is a support for you.  Cultivating a supportive spouse/partner relationship  can make a huge difference in your stress levels.  Your home and your relationship can be your “safe haven zone” where you automatically unwind and relax.   It is important to let your partner/spouse know what you need to relax and rejuvenate.  What does help you to relieve stress – relaxing music, an orderly home environment, free time to do what you want to do, or exercise that works for your body?Simple technique:  Communicate with your spouse/partner and together create a home environment that helps you relax and rejuvenate.
• Manage your work schedule so that you compartmentalize your intense work time, your less intense work time and then time to relax and rejuvenate—even if it is only ten minutes.   Be conscious about when you are feeling overly stressed and find yourself becoming “triggered” or reactive to situations in a non-productive way.   When your work schedule gets too full, find a way to create a schedule that allows you time to access some inner calm and relieve stress, so you can be responsive, productive and healthy for your patients.  Be in tune with what works for you.

Simple technique:   Be honest with yourself and pay attention to when you need to make some changes in your work schedule.  Ask your staff for help in ways you and your office staff can be more time efficient with and relieve unnecessary stress.

• Do what is known to be effective. Mindful meditation is practiced by medical professionals around the world.  Develop either an extensive or simple practice of it, depending on what you want and need.  Doing a simple meditation practice on a daily basis – relaxing your body and mind—for just 10 minutes a day can reduce your stress level immediately.  Find a meditation technique that resonates with you – that is easy and comfortable for you has been shown to work for millions of professionals.  This may involve finding a quiet space and comfortable position or activity.  The key is to focus on your breathing –in and out — which will keep you in the present, and thus relieve stress.

Doing a simple meditation on a daily basis consistently can have a huge impact on lowering your stress level.

Simple technique:   Just get started.  Find a comfortable quiet place with no distractions and just begin by with 3 deep breaths. Work your way up to 10 minutes or more, as you want.

Ultimately, you want to create a daily practice for yourself and build in activities that help you manage your stress levels.  Your daily practice consists of whatever you choose to do that effectively reduces your stress level.

It may consist of:  mindful meditation, creating quiet space, eating clean, healthy food, listening to relaxing music, personal writing, exercising:  walking, running, doing Yoga or Tai Ching, Swimming, etc., being out in nature, etc.  Whatever allows you to relax more and makes you feel good.

Your goal is to achieve a healthy career/life balance where you are enjoying a rich, personal life and and a productive, satisfying professional life.  And this begins with YOU, making new choices.

Gabrielle Parkinson, M.A., is a certified Executive Coach and specializes in career and life transitions.  You can reach her at  707-407-6828 or visit her site:  gabrielle@careerlifetransitions.org